The adjusted ferritin inflammation index: a novel metric for predicting mortality in heart failure with reduced and mildly reduced ejection fraction

doi:10.1093/eschf/xvag028

Heart failure & cardiomyopathiesCohort study

The adjusted ferritin inflammation index: a novel metric for predicting mortality in heart failure with reduced and mildly reduced ejection fraction

ESC Heart FailPublished 21 Jan 2026

retrospective cohort study

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Authors' conclusion

Adjusted Ferritin Inflammation Index is a novel inflammation-adjusted metric that independently predicts mortality in HF with reduced ejection fraction/HF with mildly reduced ejection fraction patients and outperforms traditional iron markers. Its use may enhance risk stratification and inform future strategies for iron deficiency management in HF.

Study context

Population: Patients with heart failure (HF) and reduced or mildly reduced ejection fraction (left ventricular ejection fraction ≤40% or 41%-49%) evaluated for iron parameters between January 2017 and September 2023
Participants: 322 patients

Exposure: Adjusted Ferritin Inflammation Index (AFII) ≥ 2.1 vs AFII < 2.1

Main finding

As reported in the abstract

Mortality · median follow-up of 41 months

patients died

106 patients (32.9%)

Observational data: associations, not effects.

Further findings

Outcome	Lower with AFII ≥ 2.1 ←→ Higher with AFII ≥ 2.1	hazard ratio (95% CI)	P value
Mortality, AFII ≥ 2.1 (multivariate Cox regression) · multivariate Cox regression		2.155 (1.361–3.412)	P = 0.001
	0.20.5125Hazard ratio (log scale)

3-year survival (Kaplan-Meier)

AFII ≥ 2.154.9%

AFII < 2.184.6%

Mortality, AFII ≥ 2.1 (multivariate Cox regression): independent predictor, along with New York Heart Association (NYHA) class, sodium, brain natriuretic peptide, and smoking

Ferritin and transferrin saturation, association with survival

Ferritin not associated with survival: P = 0.733
Transferrin saturation not associated with survival: P = 0.790

3-year survival (Kaplan-Meier)

significantly reduced survival in patients with AFII ≥ 2.1 across the overall cohort

Predictive performance (AUC)

AFII AUC: 0.713
ferritin/CRP AUC: 0.438
albumin AUC: 0.694

Original publication

The adjusted ferritin inflammation index: a novel metric for predicting mortality in heart failure with reduced and mildly reduced ejection fraction. ESC Heart Fail. Published 21 January 2026. doi:10.1093/eschf/xvag028

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Summarised from the published abstract; every number is checked against it